Adopting optimal feeding practices is fundamental to a child’s survival, growth and development, but too few children benefit

Proper feeding of infants and young children can increase their chances of survival. It can also promote optimal growth and development, especially in the critical window from birth to 2 years of age. Ideally, infants should be breastfed within one hour of birth, breastfed exclusively for the first six months of life and continue to be breastfed up to 2 years of age and beyond. Starting at 6 months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid and soft foods.

An infant that is not exclusively breastfed could be at a substantially greater risk of death from diarrhea or pneumonia than one who is. Moreover, breastfeeding supports infants’ immune systems and may protect them later in life from chronic conditions such as obesity and diabetes. In addition, breastfeeding protects mothers against certain types of cancer and other health conditions. Adequate feeding from 6 months onwards can prevent undernutrition and decrease the risk of infectious diseases, such as diarrhoea and pneumonia. Yet despite all the potential benefits, less than half of infants worldwide are exclusively breastfed for the first six months of life, and slightly more than half are introduced to solid foods in a timely manner.

LEVELS OF RECOMMENDED FEEDING PRACTICES

Analysis of data on feeding practices among infants and young children highlights the need for accelerated programming in this area. Globally, only two out of five newborns are put to the breast within the first hour of birth, and roughly the same proportion of infants less than 6 months of age are exclusively breastfed. The data show that 74 per cent of infants are still breastfeeding at age 1. The World Health Organization (WHO) recommends that this practice continue until age 2 and beyond, by which time the prevalence of breastfeeding drops to 49 per cent.

Global estimates for appropriate feeding of children aged 6 months to 2 years are currently limited to the timely introduction of solid, semi-solid or soft foods at 6 to 8 months. However, only 65 per cent of children are benefiting from this practice. This indicates substantial room for improvement, especially since the timely introduction of solid food represents only one of eight guiding principles for age-appropriate feeding.[1] Moreover, data from a limited set of nationally representative surveys suggest that the diet of this age group is only minimally acceptable in terms of food quality and frequency of feeding.[2]

Levels of recommended breastfeeding practices vary widely among regions. The share of infants that are breastfed within one hour of birth ranges from 35 per cent in West and Central Africa to 60 per cent in Eastern and Southern Africa. In terms of continued breastfeeding at 2 years of age, levels range from 21 per cent in East Asia and Pacific to 75 per cent in South Asia. When data from five indicators relating to breastfeeding are analysed regionally, children in West and Central Africa appear to be at a distinct disadvantage. In contrast, children in Eastern and Southern Africa are most likely to receive age-appropriate breastfeeding, with the highest numbers across many of the regions across the five indicators.

Globally - just over one third of children benefit from exclusive breastfeeding (0-5 months)

Percentage of children worldwide put to the breast within one hour of birth; exclusively breastfed (0–5 months); receiving solid, semi-solid or soft foods (6–8 months); and continuing to be breastfed at 1 and 2 years, by region, 2009–2013

Globally - just over one third of children benefit from exclusive breastfeeding (0-5 months)

Percentage of children worldwide put to the breast within one hour of birth; exclusively breastfed (0–5 months); receiving solid, semi-solid or soft foods (6–8 months); and continuing to be breastfed at 1 and 2 years, by region, 2009–2013

TRENDS

Little improvement in the levels of exclusive breastfeeding has been seen over the last decade at the global level and in most regions. Least developed countries exhibited the largest gains, rising from 38 per cent to 50 per cent during the period from around 2000 to 2012. In contrast, Asian regions showed no significant change.

The proportion of infants in least developed countries benefiting from exclusive breastfeeding has increased substantially

Percentage of infants aged 0─5 months that are exclusively breastfed, by region, around 2000 and 2012

Notes: Estimates are based on a subset of 62 countries with available trend data (excludes Brazil and China due to lack of trend data). Regional aggregates are presented where adequate population coverage is reached. Rates for around 2012 may be different from those presented as ‘current regional/global estimates’, since the trend analysis is based on a subset of countries.

The proportion of infants in least developed countries benefiting from exclusive breastfeeding has increased substantially

Percentage of infants aged 0─5 months that are exclusively breastfed, by region, around 2000 and 2012

Notes: Estimates are based on a subset of 62 countries with available trend data (excludes Brazil and China due to lack of trend data). Regional aggregates are presented where adequate population coverage is reached. Rates for around 2012 may be different from those presented as ‘current regional/global estimates’, since the trend analysis is based on a subset of countries.

In West and Central Africa during the 1990s, the rate of exclusive breastfeeding increased from 7 per cent to 18 per cent. However, little progress has been seen in the last decade. Reinvigorated efforts are needed to regain past momentum in that region and to build on current successes among least developed countries.

Early successes in exclusive breastfeeding in West and Central Africa need to be revived

Percentage of infants aged 0─5 months that are exclusively breastfed, in regions with comparable trend data for around 1992, 2002 and 2012

Note: Based on a subset of countries with available data and presented where adequate population coverage is met.

Noteworthy advances in a number of countries show that it is possible to make gains in the practice of exclusive breastfeeding, even over short time periods. Twenty countries with recent data show either: a significant increase (15 percentage points or more) in the preceding five years, or high achievement (more than 50 per cent coverage), with evidence suggesting a modest increase or maintenance of that achievement in the preceding six years.

Advances in many countries show that rapid and sustained progress in exclusive breastfeeding is possible

Trends in the percentage of infants aged 0─5 months that are exclusively breastfed, in selected countries, 2005─2012

In other countries, sharp reversals in the practice of exclusive breastfeeding have been noted. This suggests that achievements are not necessarily permanent and that sustained efforts are needed to maintain them.

Sharp reversals in progress can also occur, suggesting that efforts must be sustained

Trends in the percentage of infants aged 0─5 months that are exclusively breastfed, in selected countries, 1992─2011

DISPARITIES

In terms of early initiation of breastfeeding, the poorest 20 per cent of the population fare better than their richer counterparts in three regions: Latin America and the Caribbean, East Asia and the Pacific, and the Middle East and North Africa. The usual pattern of disparities (the poor faring worse than the rich) is found in South Asia and sub-Saharan Africa. Overall, the poorest children in South Asia are at the greatest disadvantage globally in terms of early initiation of breastfeeding. In contrast, children in the poorest quintiles in Latin America and the Caribbean have the highest levels for this indicator of any income group in any region.

In three regions, poorer children are more likely than richer children to be breastfed within one hour of birth

Percentage of newborns put to the breast within one hour of birth, by wealth quintiles, 2005─2012

Notes: Estimates are based on data from 74 countries with available data by wealth quintiles. Excludes Brazil, China and Mexico due to lack of wealth quintile data.

This report builds on earlier findings on the impact of undernutrition by highlighting new developments and demonstrating that efforts to scale up nutrition programmes are working, benefiting children in many countries.

THE INDICATORS

The standard indicators for infant and young child feeding practices were developed in alignment with WHO’s Guiding Principles on feeding the breastfed and non-breastfed child. The aim is to use the guidelines to assess infant and young child feeding practices within and across countries and to evaluate progress in this programme area. While it is not possible to develop standard indicators for all desirable and recommended practices, 15 indicators (8 core and 7 optional) were developed and are presented in WHO’s 2008 publication, Indicators for Assessing Infant and Young Child Feeding Practices. Part 1: Definitions. These indicators are a culmination of six years of inter-agency work and are used to assess a subset of practices.

This set of indicators provides i) an update of the 1991 WHO and UNICEF indicators on breastfeeding practices and ii) a broad set of indicators[2] to assess, for the first time, feeding practices in children aged 6 to 23 months.

Core indicators for infant and young child feeding practices

Indicator name

Definition

UNICEF global database exists?

Numerator

Denominator

Early initiation of breastfeeding

Children born in the last 24 months who were put to the breast within one hour of birth

Children born in the last 24 months

Yes

Exclusive breastfeeding

Infants 0─5 months of age who received only breast milk during the previous day

Children 12─15 months of age who received breast milk during the previous day

Children 12─15 months of age

Yes

Introduction of solid, semi-solid or soft foods

Infants 6─8 months of age who received solid, semi-solid and soft foods during the previous day

Infants 6─8 months of age

Yes

Minimum dietary diversity

Children 6─23 months of age who received foods from ≥ 4 food groups during the previous day

Children 6─23 months of age

Coming in the State of the World’s Children 2015 report

Minimum meal frequency

Breastfed children 6─23 months of age who received solid, semi-solid and soft foods the minimum number of times or more during the previous day

Breastfed children 6─23 months of age

Coming in the State of the World’s Children 2015 report

Non-breastfed children 6─23 months of age who received solid, semi-solid and soft foods or milk feeds the minimum number of times or more during the previous day

Non-breastfed children 6─23 months of age

Minimum acceptable diet

Breastfed children 6─23 months of age who had at least the minimum dietary diversity and the minimum meal frequency during the previous day

Breastfed children 6─23 months of age

Coming in the State of the World’s Children 2015 report

Non-breastfed children 6─23 months of age who received at least two milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day

Non-breastfed children 6─23 months of age

Consumption of iron-rich or iron-fortified foods

Children 6─23 months of age who received an iron-rich food or a food that was specially designed for infants and young children and was fortified with iron, or a food that was fortified in the home with a product that included iron during the previous day

Children 6─23 months of age

No

DATA COLLECTION AND REPORTING

Data for these indicators are collected though household surveys. With the exception of early initiation of breastfeeding, they are based on questions about liquid and food intake of children aged 0─23 months in the 24 hours preceding the survey. Standard questions and other practical methodological instructions for the core and optional indicators are available in the WHO document, Indicators for Assessing Infant and Young Child Feeding Practices. Part 2: Measurement. Large household survey programmes, such as MICS and DHS, are major sources of country-level estimates for seven of the core indicators as well as a subset of the optional indicators. Other national household surveys, such as national nutrition surveys, often include questions used to report on these indicators as well.

[2] These dimensions include continued breastfeeding or minimum milk feeds, appropriate timing of introduction of solid, semi-solid and soft foods, as well as optimum quantity and quality of foods consumed.

[3] Note that continued breastfeeding at 2 years (20─23 months) is an optional indicator, but is included in UNICEF’s global database.